Doesn’t anyone have a family doctor anymore? Apparently not.

In this month’s Health Affairs journal, a startling new finding[1] – 42% of the annual visits for acute care happen somewhere else other than a primary care doctor’s office. These are visits for new problems and are usually exactly the kind of thing a family physician, pediatrician, or internist should be first to speak with a patient about. Instead, patients are being seen in emergency rooms, specialists’ offices, and outpatient clinics, three of the most expensive places to get care in our system and three of the places least equipped to deliver high-quality primary health care.

On the one hand this shouldn’t be that surprising. After all, we pay twice as much for our health system as any other wealthy country and, as anyone with extensive experience with the system knows, often get disorganized and maddening service despite this enormous expense. A refocus on primary care is part of the new health care law. Primary care doctors will be paid more, preventive services will be exempt from all copays, deductibles and other charges for almost everyone next year, and new ways of paying for care that stress the importance of the family doctor are already being studied.

However, as this research shows, the system will need pretty substantial change to shift the focus away from the lower-quality and more expensive ways of delivering care.